Digestive Endocrinology and Glucose Metabolism

Question 1

Alpha cells

Answer 1

Glucagon

Question 2

Beta cells

Answer 2

Insulin

Question 3

Delta cells

Answer 3

Somatostatin

Question 4

T or F: The pancreas is retro-peritoneal

Answer 4

True

2nd lumbar vertebral level

Question 5

Endocrine pancreas

Answer 5

Accounts for 2% of pancreatic mass

Islets of langerhans

Question 6

Glucagon

Answer 6

Produce increase in blood glucose
Breakdown of glycogen
Stimulates gluconeogenesis
Make fatty acids available for energy
Released in response to low glucose levels, high AA concentration and exercise

Question 7

Insulin

Answer 7

Lowers blood glucose
Promotes uptake of glucose by target cells
prevents fat and glycogen breakdown
Promotes fat storage

Question 8

Which circulation does insulin enter?

Answer 8

Portal circulation

Question 9

How is insulin release regulated?

Answer 9

Glucose enters cells and becomes glucokinase, resulting in closure of K and opening of Ca channels resulting in exocytosis of insulin.

Question 10

Acinar cells secrete?

Answer 10

digestive enzymes

Question 11

What do the hepatic duct and pancreatic duct secrete through into the duodenum?

Answer 11

Papilla of Vater which is surrounded by the sphincter of Odi.
Darth Vater and Odi one kanobi

Question 12

Hypoglycemia early signs

Answer 12

Sweating/palpitations/tremor
nervousness/irritability
parasthesias
Hunger
N/V

Question 13

Hypoglycemia late signs

Answer 13

HA, tired, drowsy
Dizzy/syncope
Blurred vision, confusion
abnormal behavior
Seizures, Coma

Question 14

Whipples triad

Answer 14

1. Group of symptoms associated with hypoglycemia.
2. Low plasma glucose (<55)
3. relief of symptoms by raising glucose

Question 15

Reactive hypoglycemia

Answer 15

Severe exercise
Medication use
-insulin, Beta blockers
-bactrim
-haloperidol
-MOA inhibitors

Question 16

Functional Hypoglycemia

Answer 16

Hepatic and renal dysfxn
Malnutrition
Endocrinopathies
-adrenal insufficiency
-GH deficiency
-glucagon insuficiency
Pancreatic tumors
Alcohol consumption

Question 17

Neuroglycopenic Presentation

Answer 17

Usually a result of fasting hypoglycemia
Result from decreased glucose supply to CNS and PNS.
HA, confusion, slurring speech, coma, seizures, neuromuscular sx.

Question 18

Andregenic Presentation

Answer 18

Caused by abrupt decrease in glucose level
Release of epi
Hunger, diaphoresis, weakness, palpitation

Question 19

Diabetic Ketoacidosis

Answer 19

Insulin deficiency, hyperglycemia
Blood glucose >250, ketones, acidosis
Most commonly seen in type 1
Can also happen in type 2
Onset of hours to days

Question 20

DKA leads to…

Answer 20

Dehydration
Increased osmolarity (<320)
Increased serum amylase
Elevated white count
Hypertriglyceridemia

Question 21

DKA causes

Answer 21

Infection
New onset diabetes
Insulin administration
Stress

Question 22

DKA Symptoms

Answer 22

N/V
Polyuria, polydypsia
Abd pain
weakness/fatigue/anorexia

Question 23

DKA signs

Answer 23

Tachycardia
Hypotension
poor skin turgor
dry skin/mucous membranes
Kussmaul respirations
Hypothermia
Fruity breath
AMS, coma

Question 24

T of F: DKA causes hyperosmolarity.

Answer 24

True
Osmotic diuresis leads to dehydration
Decrease in serum bicard = acidosis

Question 25

Breakdown of fatty acids for energy leads to production of?

Answer 25

Ketones

Hypertriglyceridemia

Question 26

DKA tx

Answer 26

NS 1L/hr x 2 hrs
Watch Na: replace if needed
When glucose is <250, switch to dextrose .05%

Question 27

DKA insulin therapy

Answer 27

10U IV bolus
Drip 6U/hr
Dont decrease glucose level too fast
check blood sugar hourly

Question 28

Once DKA patients can eat and drink, change insulin to from IV to….

Answer 28

SQ

Question 29

Hyperglycemic Hyperosmolar Nonketotic Syndrome

Answer 29

Occurs exclusively in type 2
Elderly, physically impaired
Limited access to free water
High (>600) hyperglycemia
absence of acidosis
Greater dehydration